Modern Gastroenterology PC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

MODERN GASTROENTEROLOGY PC

Practice address

2705 Mermaid Ave
Brooklyn, NY 11224-2005

Phone

(718) 265-2222

Fax

(718) 333-1023

NPI assigned

Sep 20, 2014

Last updated

Sep 20, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Konstantin Vaizman, MDNPI 1639268105

Title

Medical Director

Phone

(347) 446-6839

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Konstantin Vaizman, M.D.

  • Gastroenterology Physician
  • Brooklyn, NY
  • NPI 1639268105
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411171200000",
    "number": "1578965638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "947 79TH ST",
            "address_2": "STE 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112282613",
            "telephone_number": "347-446-6839",
            "fax_number": "718-333-1023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 MERMAID AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112242005",
            "telephone_number": "718-265-2222",
            "fax_number": "718-333-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN GASTROENTEROLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-20",
        "last_updated": "2014-09-20",
        "status": "A",
        "authorized_official_last_name": "VAIZMAN",
        "authorized_official_first_name": "KONSTANTIN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "347-446-6839",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Gastroenterology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.